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Introduction. Pediatric services - Preventive -Promotive - Curatative - Rehabilitative Most cost effective health intervention Reduces morbidity and mortality. Historical Aspects. 1796,Edward jenner :1 st small pox vaccine 1885,Louis pasteur: rabies vaccine - PowerPoint PPT Presentation
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Introduction Pediatric services - Preventive -Promotive - Curatative - Rehabilitative Most cost effective health intervention Reduces morbidity and mortality
Transcript
Page 1: Introduction

Introduction

Pediatric services

- Preventive

-Promotive

- Curatative

- RehabilitativeMost cost effective health interventionReduces morbidity and mortality

Page 2: Introduction

Historical Aspects

1796,Edward jenner :1st small pox vaccine 1885,Louis pasteur: rabies vaccine 1974 WHO: EPI(<5yr and preg;

BCG,DPT,OPV, measles and TT) 1978 GOI : EPI- BCG,DPT and typhoid 1979 OPV added the measles

Page 3: Introduction

Basics of Immunization

Immune (Greek): To be protected Immunization: Process of inducing immune

response which may be humoral or cellular. (active-ag, passive- ab)

Vaccine : Antigen of the pathogen which induces a protective immune response without suffering from disease.

Vaccination: Process of inoculating the vaccine / antigen

Page 4: Introduction

The system of transporting, storing and distributing vaccines in a potent state at the recommended temperature from the point of manufacture to the point of use is the Cold Chain

Essential components include 1. Manpower – motivated and trained 2. Equipment to store and transport 3. Transport facilities 4. Maintenance of equipment 5. Monitoring

Cold Chain

Page 5: Introduction

Storage of vaccines in refrigerator

Page 6: Introduction

Timings of vaccination

Depends upon the age at which the disease is anticipated as well as on the feasibility of administering the vaccine at that time.

BCG,OPV and HBV can be given soon after birth as the maternally derived immunity apparently does not interfere with the vaccine “take”.

Measles vaccine given after 9months as detectable maternal antibody may inhibit it before 9 months

Page 7: Introduction

Interval of vaccination

Interval between two doses of same vaccine ,say for instance DPT, should be at least 4weeks; preferably 8weeks

Interval of 4weeks why? Early completion of primary schedule Easier to remember by parents Decrease drop out rates

BCG and OPV can be given from birth until 2weeks of age , so that there would be 4week gap until next contact at 6week

Page 8: Introduction

Route of administration

Oral : OPV & typhoid Ty 21Sub cutaneous: measles & MMRIntradermal: BCG volar surface of

forearmIntramuscular: typhoid, DPT, HB,HA, Hib

(antlat thigh in infants & deltoid later)

Page 9: Introduction

Safe Injection Practices

Separate syringe and needle for each injection

Separate anatomical site and separate limb for multiple injections

Observation of child for at least 15 minutes after administration of an injection

Page 10: Introduction

Minimum Resuscitative Equipment

Airway, ambu bag, mask, IV access (scalp vein, venflon), oxygen cylinder

Injection adrenaline (1: 1000 solution)IV hydrocortisoneNormal saline

Page 11: Introduction

Types of VaccinesType of antigen Examples

Live bacteria, attenuated

BCG, Ty21a

Live virus, attenuated OPV ,MMR, Varicella

Inactivated bacteria Pertussis, whole cell killed typhoid

Inactivated virus IPV, Rabies, HAV

Toxoid DT,TT,Td

Capsular polysacharide Typhoid Vi, Hib, Meningococcal, pneumococcal

Viral subunit HBsAg

Bacterial subunit Acellular pertussis

Page 12: Introduction

National Immunization Schedule

Age NIS

Birth BCG, OPV0

6week DPT, OPV, HepB, Hib 1

10week DPT, OPV, HepB, Hib 2

14week DPT, OPV, HepB, Hib 3

9-12months Measles

16-24months DPTB1,OPV4 ,MMR

5-6yrs DPT

10yr and 16Year TT

Pregnant women TT1 &2

Vitamin A 9, 18, 24, 30 & 36months

Page 13: Introduction

BCGBCG Bacillus of Calmette And Guerin

Type LAV, Dannish 1331 strain

Content/ dose 0.1-0.4million viable bovine mycobacteria,

Nature /diluent Lyophilized , normal saline

Storage Freezer / 2-8degree C, protect from light

Dose/route/site 0.1ml ID , lt deltoid, use within 4hrs of dilution

Schedule Single dose at birth or first contact below 5years

Protective efficacy 0-80%

Major adverse effects Axillary lymphadenitis

Contraindications Cellular immunodeficienyShould not be given with measles

Other use Some protection for leprosy and leukemia . Bladder cancer

Page 14: Introduction

OPV

Community vaccine

Type LAV

Content/ dose Sabin strain Type 1,2 &3

Nature /diluent Liquid

Storage Freezer / 2-8degree C

Dose/route/site 2 drops (0.1ml), oral (total 6dose)

Schedule Birth ,6,10 &14wks, 15-18mo,5yrs, NIDS, & SNIDs

Protective efficacy 10-15% per dose

Major adverse effects Rarely VAPP

Contraindications Immunodeficient patients and house hold contacts

Questions: 1. strategy of polio eradication 2. pulse polio,

3. mopping up. 4. Ring immunization

Page 15: Introduction

IPV

IPV Inactivated Polio Vaccine (IMOVAX POLIO)

Strain Salk Trivalent (Lansing, Leon and Brunhide )

Content Type 1-40units, type2 -8units, type3- 32units

Dose 0.5ml

Route S/C or IM antlat aspect of thigh or deltoid

Schedule 6,10.14 weeks and booster at 15months

Storage 2-8 degree centigrade

Protective efficacy

98%

Dr Jonas salk -1976 Nehru award at AIIMS for international understanding

Page 16: Introduction

DPwT / DTaP: Triple vaccineType LAV (

Content/ dose Diphtheria toxoid 20-30 Lf, Tetanus oxoid 5-20Lf, wP 4IU / aP 3-25mcg of 2-5 pertussis antigens

Nature /diluent Liquid vaccine

Storage 2-8degree C, avoid DTaP from from light

Dose/route/site 0.5ml im , thigh / deltoid

Schedule 6,10 &14wks, booster at15-18mo,5yrsNot recommended above 7yrs

Protective efficacy 95-100% for diptheria /tetanus and 70-90% for pertussis

Major adverse effects

More with DPwP high fever,excessive cry, seizure, encephalopathy

Contraindications Serious hypersensitivity, Encephalopathy with previous dose

Tdap: reduced antigen for older children and adolescent

Page 17: Introduction

MEASLES

Type LAV

Content/ dose 1000CCID50 of Edmonston Zagreb strain

Nature /diluent Lyophilized , diluent sterile water

Storage Freezer / 2-8degree C, protect from light

Dose/route/site 0.5ml s/c thigh/ deltoid

Schedule Single dose at 9months

Protective efficacy 80%

Major adverse effects Mild measles like illness in <5%, rarely thrombocytopenic purpura

Contraindications Severely immunocompromised, pregnancy

Precaution Reconstituted vaccine must be employed in the same day and leftover is discarded

Page 18: Introduction

RUBELLA

Type LAV

Content/ dose 5000CCID50 of RA 27/3 strain of rubella virus

Nature /diluent Lyophilized , diluent sterile water

Storage Freezer / 2-8degree C

Dose/route/site 0.5ml s/c thigh/ deltoid

Schedule As for MMR, MMR preferred, adol girl

Protective efficacy 95%

Major adverse effects Mild rubella like illness in <5%, rarely arthritis and ITP

Contraindications Severely immunocompromised, pregnancy

Page 19: Introduction

MMR Priorix

Type LAV

Content/ dose Measles and rubella as above, 5000CCID50 of mumps jeryl lynn/ urabe strain

Nature /diluent Lyophilized , diluent sterile water

Storage Freezer / 2-8degree C, protect from light

Dose/route/site 0.5ml s/c thigh/ deltoid

Schedule Two doses at 15-18months and 5years

Protective efficacy 80%

Major adverse effects Mild measles like illness in <5%, rarely thrombocytopenic purpura

Contraindications Severely immunocompromised, pregnancy

Jeryl - Linn-named after the child from whom it was derived , dose 317TCID

Page 20: Introduction
Page 21: Introduction

HEPATITIS B

Type Recombinant (Engerix B)

Content/ dose 25mcg /ml of HBsAg

Nature /diluent Liquid vaccine

Storage 2-8 degree C

Dose/route/site <18yr 0.5ml (10mcg), >18yr- 1ml IM deltoid / thigh

Schedule Birth, 6wk &14wks6,10,14wks0, 1& 6months

Protective efficacy 90%

Major adverse effects None

Contraindications Serious hypersensitivity

Page 22: Introduction
Page 23: Introduction

HIB VACCINE

Hiberix , ACT- HIB

Type Subunit , conjugated polysacharide vaccine

Content/ dose 10mcg of PRP-T or HbOC

Nature /diluent Lyophilized/ liquid , diluent sterile water

Storage 2-8degree C

Dose/route/site 0.5ml im thigh/ deltoid

Schedule 6,10.&14wks, booster at 15-18months

Protective efficacy >90%

Major adverse effects None

Contraindications Severely immunocompromised, pregnancy

Page 24: Introduction

HEPATITIS A VACCINE

Type Killed (HAVRIX)

Dose 1-18yr-720units, >18yr:1440 units single dose, booster after 6-12 months

Storage 2-8

Side effects Pain,fever and malaise

Page 25: Introduction
Page 26: Introduction

VARICELLA /CHICKEN POX

VARILRIX , OKAVAX

Type LAV

Storage 2-8degree C

Dose/route/site 0.5ml S/c thigh/ deltoid

Schedule Given after 1yr of age<13yr Single dose, >13yr 2dose 6-10wk apart

Protective efficacy 80%

Major adverse effects Rare

Contraindications HIV with lymphopenia and neomycin hypersensitivity

OKAVAX is given only single dose

Page 27: Introduction
Page 28: Introduction

TYPHOID VACCINE

Types 3 types: Vi polysacharide (available in india) - whole cell inactivated and - oral Ty 21a

Dose 0.5ml IM inactivated Vi psv

Schedule First dose after 2yr and booster every 3year

Efficacy 70%

Storage +2 to +8%

Page 29: Introduction
Page 30: Introduction

Pneumococcal Conjugate Vaccine (PCV 7)

Type Conjugate capsular polysacharide vaccine

Content/ dose Contains 2mcg of serotype 4,9V,14,18c,19F, 23F and 4mcg of serotype 6B (7 valent)

Nature /diluent Liquid form

Storage +2 to +8degree C

Dose/route/site 0.5ml IM antlat aspect thigh/ deltoid

Schedule 3 primary doses 6,10,14wks.booster 12-15months

Protective efficacy 97.4%

Major adverse effects Local reactions and fever, GBS, relapse of ITP

Contraindications Known hyper sensitivity

Page 31: Introduction

MENINGOCOCCAL VACCINE

Type Inactivated capsular polysacharide vaccineBivalent: (A+C), tetravalent: A, C,Y& W135

Content/ dose 50mcg each A &C serotype

Nature /diluent Lyophilized , sterile water

Storage +2to +8degree C, protect from light

Dose/route/site 0.5ml IM or S/C thigh/ deltoid

Schedule 2years and above during epidemics

Indication Chemoprophylaxis in close contactsA/Hyposplenia, complement deficiencyHaj pilgrimage

Protective efficacy 90% against the covered strains

Major adverse effects Mild fever & local reaction

Page 32: Introduction
Page 33: Introduction

RABIES

Type Tissue culture inactivated vaccineHDCV- Human diploid cell vaccinePCEV- Purified chick embryo cell vaccine (rabipur)

Content/ dose >2.5 IU of inactivated rabies antigen

Nature /diluent Lyophilized , diluent sterile water

Storage 2-8degree C, protect from light

Dose/route/site 1ml IM deltoid

Schedule Pre exposure-Three doses: day 0,7 & 28Post exposure-5doses day-0,3,7,14 & 28

Protective efficacy 90-100%

Adverse effects Local pain

Seroprophylaxis Rabies human immunoglobulin (RHIG) 20IU/kg single injection in all cases with severe exposure

Page 34: Introduction

Combination vaccines currently licensed in Pakistan

o DTwP+ Hib, o DTwP+ Hep B, o DTwP+Hib+ HepBo DTaP+ IPV+HepB

Page 35: Introduction

1. Inj epinephrine (1:1000 solution) 0.01 ml/kg/dose (max 0.5 ml)im in anterolateral thigh

2. Set up IV access3. Lie patient flat and elevate legs if tolerated.

4. Give high flow oxygen and airway/ ventilation if needed

5. If hypotensive also, set up additional wide bore access and give IV NS 20 ml/kg under pressure over 1-2 minutes6. IM adrenaline may be repeated after 3-5 minutes if required

7. Oral antihistaminics may be given.8.Injectable corticosteroids may be given .

Emergency management of anaphylaxis


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